What Is Addiction?

Addiction is an allergic reaction in the brain, an allergy

Do you know someone who is allergic to bee stings? Or peanuts? What happens to them when they are exposed to the substance? Most often, when a person with a peanut allergy ingests peanuts, their throat swells, their pulse goes up, they may even lose consciousness unless they get immediate medical attention. This is weird, right? Most people don’t have this reaction to peanuts. This allergic reaction only occurs for a small percentage of people (around 1%). There is no known cure besides abstinence.

Alcoholism/Addiction is also an allergy. An allergy is an abnormal reaction to a substance. People with a genetic history of alcoholism or addiction are born with a higher level of vulnerability to developing the disease of addiction themselves. Those with the disease of addiction have a different response/reaction in their brain to addictive substances (or pleasurable/addictive behaviors such as gambling) than a person without the disease of addiction would have. When a person with the disease of addiction drinks or uses a substance (or engages in an addictive behavior) the abnormal reaction (the allergic reaction) that occurs is: the brain wants more. Whereas, the person without the disease of addiction can take it or leave it and stop when they want to stop.

To prove this allergic reaction, Dr. Marc Schuckit, a researcher, psychiatry professor, and director of an addiction treatment program has been conducting a study on sons of alcoholics. His study found that when sons of alcoholics had an initial low response to alcohol (meaning, they had an initial higher tolerance to alcohol than others), they were 60% likely to go on to develop alcoholism.

Addiction is a Disease

The criteria for addiction to be called a disease:

Primary – Addiction is called a primary disease, meaning it must be treated first and it is not caused by anything else. It exists on its own. Co-occurring disorders may exists (and usually do) such as depression, bipolar disorder, anxiety disorder, etc, but many of these disorders are caused by the use of substances or are related to withdrawal from substances and are disguised as mental illness (for more on this see the “Withdrawal” section). If a person seeks treatment and is able to maintain abstinence, the symptoms of their co-occurring disorder oftentimes go away completely or at the very least become much more treatable/manageable. If a person with an addiction disorder seeks treatment for their co-ocurring disorder but continues to use substances or engage in the addictive behavior, the symptoms of the disorder are likely to continue or worsen (for example, if a person seeks treatment for depression but they are still drinking, their depression is not likely to get any better and may actually get worse.).

Chronic – The disease of addiction is chronic, meaning there is no cure. Also, relapse is a part of the disease (see “Relapse” page for more information on relapse). Statistics vary, but a popular one states that 8 out of 10 people who seek treatment relapse within the first year (some studies claim that this rate is actually higher). That is an 80% relapse rate. This means that it is quite often the rule, not the exception that people relapse. The reason for this is due to the neurochemical changes in the brain and the amount of time that it takes for the brain to heal (See “A Drive, Not a Choice” Section for more info on this).

Progressive – The disease of addiction gets worse, not better, with time. The popular phrase in 12-step circles is that addiction ends only in jails, institutions, and death if left untreated. Tolerance to substance is progressive, and the consequences that come with continued use are progressive. Meaning with continued use and tolerance comes an increase in use and an increase in use leads to more and more problems in a person’s life such as: family/relationship problems, social problems, job problems, health problems, emotional problems, cognitive problems, legal problems, spiritual problems, etc.

Fatal – can and will cause death (for example, death by car accident, suicide, liver failure, homelessness, or other complication from the use of the substance)  if left untreated. Addiction is the only disease that takes everything from you and THEN it kills you.

Diagnostic Criteria:

These are the criteria that a person with a substance disorder must meet in order to receive a diagnosis of abuse or dependence according to the DSM-IV (the diagnostic statistical manual of mental disorders – 4th edition). A diagnosis of abuse may be a precursor to a diagnosis of dependence:

DSM-IV Substance Abuse Criteria

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).

2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)

3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)

4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and/or physical fights).

Alternatively, the symptoms have never met the criteria for substance dependence for this class of substance.

DSM-IV Substance Dependence Criteria

Addiction (termed substance dependence by the American Psychiatric Association) is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

1. Tolerance, as defined by either of the following:

(a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect

(b) Markedly diminished effect with continued use of the same amount of the substance. 
2. Withdrawal, as manifested by either of the following: 
(a) The characteristic withdrawal syndrome for the substance 


(b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. 
3. The substance is often taken in larger amounts or over a longer period than intended. 
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use. 
5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 
6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 

7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). 

DSM-IV criteria for substance dependence include several specifiers, one of which outlines whether substance dependence is with physiologic dependence (evidence of tolerance or withdrawal) or without physiologic dependence (no evidence of tolerance or withdrawal). In addition, remission categories are classified into four subtypes: (1) full, (2) early partial, (3) sustained, and (4) sustained partial; on the basis of whether any of the criteria for abuse or dependence have been met and over what time frame. The remission category can also be used for patients receiving agonist therapy (such as methadone maintenance) or for those living in a controlled, drug-free environment.




  1. The latest edition of the DSM (DSM-V) includes many changes to the language of addiction, however, the criteria for recognizing whether or not someone has a problem with substances have not changed. For instance, the DSM-V now calls it a Substance Use Disorder (or it may be specified as Alcohol Use Disorder or Opiate Use Disorder, etc). This language is less stigmatizing than terms of the past, which is good. However, the above criteria are still very helpful for the general public to gain a basic understanding of what a substance use disorder might look like in terms of consequences and behaviors.


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